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Purpose <p>To describe a dual-layer collagen graft closure method for dural defects during endoscopic skull base surgery and assess its safety and feasibility in preventing postoperative cerebrospinal fluid (CSF) leaks.</p> Methods <p>This technical note outlines a five-year, single institution experience involving ten patients undergoing endonasal endoscopic surgery for lesions involving open cisterns or dural breaches. A prefashioned collagen matrix (Duragen) graft, assembled with a perpendicular inlay-onlay design and centrally sutured, was used along with a nasoseptal flap. Postoperative CSF leak rate and technical handling characteristics were documented.</p> Results <p>Among ten cases, no postoperative cerebrospinal fluid (CSF) leaks were observed during a follow-up period ranging from 6 to 24 months. Graft placement was described as feasible without the use of fat, balloon, or external buttresses. No complications related to graft migration or infection were reported.</p> Conclusion <p>This variation of the bilayer button - DanNish technique utilizes a centrally yoked collagen inlay-onlay configuration with nasoseptal flap support. It appears to be a feasible and potentially effective option for skull base dural reconstruction. Further studies with larger cohorts and comparative analysis are warranted to evaluate its clinical utility.</p>

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Endoscopic Restoration of Cranial Base Defects Utilizing a Dual-Layer Collagen Intra-Extradural Sandwich Graft Technique (Inlay-Overlay) – the DanNish Technique

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Nishit J. Shah,
  • Daniel M. Prevedello,
  • D. Mrinmayi

摘要

Purpose

To describe a dual-layer collagen graft closure method for dural defects during endoscopic skull base surgery and assess its safety and feasibility in preventing postoperative cerebrospinal fluid (CSF) leaks.

Methods

This technical note outlines a five-year, single institution experience involving ten patients undergoing endonasal endoscopic surgery for lesions involving open cisterns or dural breaches. A prefashioned collagen matrix (Duragen) graft, assembled with a perpendicular inlay-onlay design and centrally sutured, was used along with a nasoseptal flap. Postoperative CSF leak rate and technical handling characteristics were documented.

Results

Among ten cases, no postoperative cerebrospinal fluid (CSF) leaks were observed during a follow-up period ranging from 6 to 24 months. Graft placement was described as feasible without the use of fat, balloon, or external buttresses. No complications related to graft migration or infection were reported.

Conclusion

This variation of the bilayer button - DanNish technique utilizes a centrally yoked collagen inlay-onlay configuration with nasoseptal flap support. It appears to be a feasible and potentially effective option for skull base dural reconstruction. Further studies with larger cohorts and comparative analysis are warranted to evaluate its clinical utility.